Mr. Howard wasn’t himself. He was disoriented, combative, trying to crawl over the bed rails. The man I had known—the man who had cared for his wife with dementia, who always remembered my name—was now lost in delirium. His confusion rendered him at risk for falling. The bedrails made him feel trapped, no longer in control.
His wife, sitting at his bedside with a notebook, scribbled words she wouldn’t remember later. But writing made her feel useful. It gave her a sense of control over her jumbled thoughts.
It was heartbreaking.
Delirium is a temporary change in mental status. There are many root causes for delirium, but in the elderl,y the most likely are infections and medication. In Mr. Howard’s case, it was a urinary tract infection. I knew his mental status would improve with treatment, but at this moment, he needed to regain a sense of control.
I helped Mrs. Howard up and we walked to the bedside.
“George, you stop that fussin.”
I was surprised by the clarity of her stern voice. But he heard her, and his thrashing diminished. I lowered the bed rail as we hovered to make sure he didn’t roll out of bed. His wild eyes focused upon his wife, and he took a deep breath and sighed as he rested his head back on the pillow. She patted him on the head and smiled.
Mr. Howard’s life revolved around caring for his wife. I believe his distress stemmed from the inability to control his circumstances to get to her. When she was okay, he became okay.
The Power of Autonomy
When we are young, our hubris often leads us to believe that our future is in our control, our destiny defined by our decisions. With age and experience we understand that only a portion of our life experience reflects our autonomy. We grip tightly to that which we control and, with wisdom, let go of what we can’t.
When we consider Mr. Howard, that could be some of us now, and all of us one day. It is a sobering reality.
Caring for aging parents may already give insight into this deep need for autonomy. The thought of moving from a family home or giving up car keys for safety reasons is met with great resistance.
This desire for autonomy was acutely felt in the family of a friend. Her widowed mother lived at home with a medical assistant 24/7. One day the mother found car keys that had been hidden for many months. She slipped out and drove away. Within a mile of her home she was killed instantly when she failed to stop at a red light and was hit by a cement truck.
Desiring autonomy is universal. To maintain autonomy for as long as possible requires planning and open dialogue. Discussion about the evolution of safe autonomy should be had before the need ever arises. It becomes less frightening. When we write a plan, it becomes a guide for the future, and our autonomy is maintained even though our circumstances change.
When I had this discussion with my mother, she was at first resistant. Her sense of control is uniquely linked to the ability to drive. Sharing stories and statistics of elderly drivers who had chosen to drive beyond their capacity to do so forced her to reckon with the reality that one day, she will have to give up her keys.
The decisions my mother made reflected her wishes for a future time. It helped her to know that every decision made, I also committed to. I committed to honor her wishes and also use the same criteria. It is a gift to our children when we develop a plan. The fullness of this gift is not known until the time arrives when it is implemented.
Mr. Howard recovered from the infection and his mental status returned to the funny, competent man I knew. Before departing we discussed with his daughter the planning they needed to do as a family. Mrs. Howard took scribbled notes. The plan began with a continuum of care for Mrs. Howard in the event of a medical crisis for Mr. Howard. By beginning with her needs, he felt less threatened by the topic of discussion.
When we take time to plan ahead, we create space for peace. We regain our footing in what feels like unfamiliar territory. If you would like a free resource for creating a plan you can do so by following this link to the Planning for Peace Checklist. There is also a checklist and a resource entitled, When Decisions Should be Shared, in the appendices of Anticipating Heaven.
This is also why I wrote Anticipating Heaven—because preparation isn’t just medical, it’s logistics, it’s financial, it’s…a lot! But most of all it is spiritual. And when we live with the end in mind, we start to live differently—more generously, more fully, and with deeper trust in what’s to come.
You may not be able to control the future. But you can walk into it with courage.
